Arthroscopy versus physical therapy in degenerative tears of the meniscus and/or knee OA

Study Type: ACE Review
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
8 ACE Reports (all randomized controlled trials) from the OrthoEvidence database were included in this review/meta-analysis examining the effect of arthroscopic surgery and physical therapy in the treatment of degenerative tears of the meniscus and knee osteoarthritis. The purpose of this review was to determine if any differences in outcome were demonstrated between arthroscopy followed by physical therapy versus physical therapy alone, regarding pain, function, satisfaction, adverse events, or osteoarthritis progression. Pain results were Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Sponsor: Conflicts:
Non-Industry funded Canadian Institutes of Health Research None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health Royalties
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Sigrid Juselius Foundation; Competitive Research Fund of Pirkanmaa Hospital District; Academy of Finland Other
Funding: Sponsor: Conflicts:
Non-Industry funded Department of Veterans Affairs None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Arthroscopic debridement and meniscectomy are commonly performed in cases of degenerative tears of the meniscus. These surgical interventions have been thought to provide appreciable symptomatic relief for patients, although the true efficacy of these procedures has been challenged as of late. Postoperative rehabilitation consisting of physical therapy is the current standard following these procedures, and some researchers suggest it is physical therapy, not necessarily the surgical intervention, which is responsible for the alleviation of symptoms. It is crucial to determine if the benefits that are observed are attributed to the surgical intervention or if they can be achieved using conservative options. Numerous randomized control trials have been performed to investigate this question, but a systematic review and meta-analysis has yet to be conducted on the topic.
What was the principal research question?
Does arthroscopic surgery provide better outcomes in the management of degenerative meniscal tears and/or osteoarthritis of the knee, when compared to conservative treatment alone?
Report Characteristics: 8 ACE Reports were retrieved from the OrthoEvidence database which investigated physical therapy regimens versus arthroscopic surgery in the treatment of degenerative tears of the meniscus and/or osteoarthritis of the knee. A supplementary search of PubMed was also performed to identify any possible additional publications. All included reports were of randomized controlled trials. The publication dates of the included studies ranged from July 2002 to December 2013. The 8 studies included a total of 1145 patients.
Report Selection: Key terms of 'meniscus', 'meniscus tear', 'degenerative', 'physical therapy', 'arthroscopy', and 'knee osteoarthritis' were used to search for relevant articles. Inclusion criteria for the review were as follows: 1) treatment of degenerative tears of the meniscus or knee osteoarthritis, or both, 2) compared arthroscopic surgery (partial meniscectomy, debridement) followed by physical therapy to physical therapy alone, or arthroscopic surgery to sham surgery that was followed by physiotherapy, 3) reported outcome of patients regarding pain, function, disability, adverse events, or progression of osteoarthritis (if applicable).
Outcomes: Outcomes that were evaluated among the included studies were the Knee Injury and Osteoarthritis Outcome Index, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Knee-Specific Pain Scale (KSPS), pain visual analog scale (VAS), Lysholm score, Short From 36-item Health Survey Physical Component Score (SF-36 PCS), Tegner activity scale, patient satisfaction, adverse events, and incidence of osteoarthritis progression.
Heterogeneity: Heterogeneity was assessed using the I-squared statistic for outcomes where pooling was acceptable.
Report Details and Scores
Pooling and Statistical Analysis
Main Findings
Figure 1. KOOS Pain
Figure 2. Composite Pain (combination of KOOS, WOMAC, KSPS)
Figure 3. VAS Pain
Figure 4. Patient Satisfaction
Figure 5. SF-36 PCS
What should I remember most?
Implications for patient treatment and future research:
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Dr. Mark Baker
March 21, 2014
Orthopaedic Surgeon - Australia
So arthroscopy will help some and as usual the challenge is patient selection and the extent of surgery. Is it worth the 2 year wait for the individual? How will the individual cope? How many are made worse? Are they simply balanced by a similar number made better? Should the ones not coping go straight to arthroplasty? What we need is selection criteria for those who will benefit and those not to touch.